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1、霍奇金淋巴瘤的诊治进展四川大学华西医院贾永前2011.3.19南宁2010美国NCI发布的SEER前十大肿瘤淋巴瘤骨髓瘤在世界的发病和死亡分布图WHO2004.svgBlood2008,111:2997-2983美国NCI1980-2004年SEER有关HL发病资料霍奇金淋巴瘤的生物学特点HRS细胞及LP细胞起源于生发中心B淋巴细胞细胞标记与B细胞有异同，CD20CD30+,CD15+HRS细胞EBER+40%信号通路的异常，NFκB的普遍过度表达新的药物的试用霍奇金淋巴瘤的治疗策略放射治疗全淋巴次全淋巴区域淋巴受累区域（
2、IFR）剂量503520cGr化学治疗干细胞移植生物治疗抗体CD20CD30表观调控治疗乙酰化酶抑制剂单纯放疗？联合治疗？Connors，etal：Vancouverexperience2010NCCN有关HL治疗指南两个疗程化疗后的IPS积分和PET/CT评估结果NCCN关于HL危险度的建议预后不良及晚期HL的治疗策略放射治疗和联合化疗DFS80%特别是年轻患者,治疗相关的晚期毒性!!HL治疗的挑战:治愈率VS毒性Developedinthemid1960sNCIVincentDeVitaetalofhistorical
3、importance.MOPPregimenMechlorethamine:6mg/m2,days1and8Vincristine:1.4mg/m2,days1and8Procarbazine:100mg/m2,days1-14Prednisone:40mg/m2,days1-14,cycles1and4onlyMOPP regimenMOPPCOPPCOPP/ABDABVDABVDintheearly1970sGianniBonadonnaandhiscolleagues.ABVDissuperiortoMOPPinte
4、rmsofDFSandhasalowerincidenceofsterilityandsecondaryleukemia.StandardchemotherapyregimenforHodgkin'slymphomaABVDregimenEvery28daysfor6ormorecycles.Adriamycin:25mg/m2,days1,15Bleomycin:10mg/m2,days1,15Vinblastine:6mg/m2,days1,15Dacarbazine:375mg/m2,days1,15ABVDregi
5、menABVDStanfordVMOPPEBVCADVAPEC-BChlVPP/EVABEACOPP（escalated）TheBEACOPPregimenwasdevelopedinGermanyVolkerDiehlandcolleaguesbeusefulforunfavorable,advanced-stageHodgkin'slymphomaHowever,escalatedBEACOPPisassociatedwithgreaterhematologictoxicityandahigherincidenceof
6、secondarymalignancies.Bleomycin:10mg/m2,day8Etoposide:200mg/m2,days1-3Doxorubicin:35mg/m2,day1Cyclophosphamide:1,250mg/m2,day1Vincristine:1.4mg/m2,day8Procarbazine:100mg/m2,days1-7Prednisone:40mg/m2,days1-14EscalatedBEACOPPregimenMEC(MOPP/EBV/CAD)ASH2010会议有关一些新的治疗
7、方案的探索关于NLPHL的R-CHOP治疗M.D.AndersonCancerCenter83例Blood(ASHAnnualMeetingAbstracts)2010116:Abstract2812E2496:ABVDvsStanfordV±RadiationTherapyinAdvancedHodgkinLymphomaPrimaryendpoint:failure-freesurvivalGordonLI,etal.ASH2010.Abstract415.ABVD6-8cyclesmodifiedIFRT36Gyon
8、lyinpatientswithmassivemediastinaldisease (n=404)StanfordV12wks’chemotherapy,modifiedIFRT36Gy tosites>5cminmaxtransversedimension (n=408)*Definedasmass≥
